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Laparoscopic cholecystectomy showing necrotic gallbladder with multiple gallstones impacted in the gallbladder wall, including a large stone (5 cm) in the neck, which compressed the CBD without fistula formation.
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... to ongoing obstruction secondary to Mirizzi syndrome, a laparoscopic cholecystectomy was performed on hospital day 7. Findings included a necrotic gallbladder with multiple gallstones impacted in the gallbladder wall, including a large stone (5 cm) in the neck of the gallbladder, which compressed the CBD without fistula formation. This confirmed type 1 Mirizzi syndrome ( Figure 5). Total bilirubin trended down, and the patient was discharged with follow up in GI and hepatobiliary surgery clinics. ...
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... Further complications of Mirizzi syndrome can include the development of biliary stricture or cholecystoenteric fistula. Pseudoaneurysm formation is rare, particularly involving the cystic artery, with only three reported cases [5][6][7]. ...
... Mirizzi syndrome is present in up to 5.7% of cholecystectomy cases [10], with type I Mirizzi syndrome accounting for 11% of cases [11]. To our knowledge, cystic artery pseudoaneurysm in the setting of Mirizzi syndrome has been rarely reported [5][6][7]. Suzuki et al. [5] reported an unruptured cystic artery pseudoaneurysm detected on cross-sectional imaging, while the other reported cases were associated with bleeding into the hepatobiliary tract [6,7]. ...
... To our knowledge, cystic artery pseudoaneurysm in the setting of Mirizzi syndrome has been rarely reported [5][6][7]. Suzuki et al. [5] reported an unruptured cystic artery pseudoaneurysm detected on cross-sectional imaging, while the other reported cases were associated with bleeding into the hepatobiliary tract [6,7]. ...
Hemobilia is an uncommon diagnosis and is often not suspected in the absence of recent hepatobiliary intervention or trauma. Hemobilia in the setting of cystic artery pseudoaneurysm secondary to type I Mirizzi syndrome is a rare occurrence. We report the case of a 61-year-old male who presented with epigastric pain and vomiting. Blood tests demonstrated hyperbilirubinemia with elevated inflammatory markers. Magnetic resonance cholangiopancreatography revealed type I Mirizzi syndrome in the presence of a 21 mm cystic duct stone. During endoscopic retrograde cholangiopancreatography, hemobilia was identified. Subsequent triple phase computed tomography imaging identified a 12 mm cystic artery pseudoaneurysm. Angiography with successful coiling of the cystic artery was accomplished. Cholecystectomy was performed, confirming type I Mirizzi syndrome. This case demonstrates the importance of considering ruptured pseudoaneurysm in patients presenting with evidence of upper gastrointestinal bleeding in the setting of biliary stone disease. Transarterial embolization, followed by surgical management, is effective in both the diagnosis and management of ruptured cystic artery pseudoaneurysm with associated hemobilia.
Giant true aneurysms of the hepatic arteries are rare. Pseudoaneurysms of the hepatic arteries are more common and are mostly caused by intra-abdominal infection, iatrogenic injury, or trauma. Hepatic or cystic pseudoaneurysms are often successfully treated by embolization owing to their saccular nature as opposed to true aneurysms. We present a case of a patient with a giant true aneurysm of the proper hepatic artery, mimicking Mirizzi syndrome. Open reconstruction was successfully preformed, and the patient made a full recovery.
